Last time I managed to discuss the building blocks of stigma with regards to mental health. The conversation around mental health stigma is rather huge and therefore it can’t be captured in one article. Today, I would like to delve into the levels of stigma. There are three levels of stigma that I would like to discuss.
Structural Stigma – (Overton & Medina). This is systemic discrimination and exclusion. At this level, stigma infiltrates all levels of society such that it affects sectors like education, housing, employment, health care systems, etc. Structural stigma plays out in terms of people experiencing barriers to employment, housing, etc. In health care systems, it comes in form of barriers to accessing and obtaining treatment services, affordability of treatment services, etc. This is largely because mental health is not highly prioritized in health and social policies. In Kenya, for example, the budgetary allocation for mental health is less than 0.1% according to the report by the mental health task force. The mental health task force in its report also notes that 75% of Kenyans cannot access mental health care. The report also notes that we have only one national mental health referral facility which was built 110 years ago and it is in a dilapidated state and lacks basic infrastructure to deliver modern evidence psychiatric care. The role of media also falls in this level because of the way it perpetuates negative images of mental illness. The media, at times, reports negatively on mental illness especially suicide and sensationalizes negative stories about people with mental health conditions.
Social Stigma – This is reflected in the interactions that people have with each other. This creates barriers to people who are trying to interact in a social environment. This has a huge impact on the experience of people diagnosed with mental illness. The public still views people with mental health conditions as dangerous and unpredictable and are therefore to be feared and avoided. Another perception that is very common is that people with mental health challenges are childlike and need to be taken care of ; incapable of being independent.
Social stigma may lead to lower one’s social status because people think less of you but also because you might experience barriers that would raise your social status like employment, education, housing, etc. Anticipation of experiencing stigma makes people reluctant to engage in social interactions and relationships. Disclosure of a mental health challenge poses a tremendous social risks which most people would rather avoid.
Internalized Stigma / Self Stigma – This occurs when the negative expectations and stereotypes that are attached to mental health conditions become internalized by a person who is diagnosed with a mental health condition. Self stigma is based on common socialization. This happens partly because an individual has been socialized in the same social context that makes the public hold stigmatizing attitudes. Another factor that may contribute to internalized stigma is the low expectations that the public and at times mental health professionals have for persons diagnosed with mental illness. Mental health professionals are still exposed to same social environment as everyone else and this exposes them to the same negative ideas that fuel public stigma.
As a person with lived experience of mental health conditions, I vow to continue challenging stigma attached to mental health issues!